<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<link rel="stylesheet" type="text/css" media="screen" href="../../css/bootstrap.min.css">
</head>
<body>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12">
	<form class="form-horizontal" onsubmit="return false" id="form">
		<fieldset>
			<div class='form-group'>
				<label class='col-md-2 control-label'>deptid</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='deptid' type='text' name='deptid' id='deptid' data-bv-notempty='true' data-bv-notempty-message='deptid 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>hostcode</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='hostcode' type='text' name='hostcode' id='hostcode' data-bv-notempty='true' data-bv-notempty-message='hostcode 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>code</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='code' type='text' name='code' id='code' data-bv-notempty='true' data-bv-notempty-message='code 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>name</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='name' type='text' name='name' id='name' data-bv-notempty='true' data-bv-notempty-message='name 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>remark</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='remark' type='text' name='remark' id='remark' data-bv-notempty='true' data-bv-notempty-message='remark 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>descs</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='descs' type='text' name='descs' id='descs' data-bv-notempty='true' data-bv-notempty-message='descs 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>address</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='address' type='text' name='address' id='address' data-bv-notempty='true' data-bv-notempty-message='address 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>examdatetime</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='examdatetime' type='text' name='examdatetime' id='examdatetime' data-bv-notempty='true' data-bv-notempty-message='examdatetime 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>patientname</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='patientname' type='text' name='patientname' id='patientname' data-bv-notempty='true' data-bv-notempty-message='patientname 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>reqdoct</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='reqdoct' type='text' name='reqdoct' id='reqdoct' data-bv-notempty='true' data-bv-notempty-message='reqdoct 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>临床诊断</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='临床诊断' type='text' name='临床诊断' id='临床诊断' data-bv-notempty='true' data-bv-notempty-message='临床诊断 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>reporter</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='reporter' type='text' name='reporter' id='reporter' data-bv-notempty='true' data-bv-notempty-message='reporter 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>chekcreporter</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='chekcreporter' type='text' name='chekcreporter' id='chekcreporter' data-bv-notempty='true' data-bv-notempty-message='chekcreporter 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>examclass</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='examclass' type='text' name='examclass' id='examclass' data-bv-notempty='true' data-bv-notempty-message='examclass 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>examsubclass</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='examsubclass' type='text' name='examsubclass' id='examsubclass' data-bv-notempty='true' data-bv-notempty-message='examsubclass 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>resultstatus</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='resultstatus' type='text' name='resultstatus' id='resultstatus' data-bv-notempty='true' data-bv-notempty-message='resultstatus 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>reqdatetime</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='reqdatetime' type='text' name='reqdatetime' id='reqdatetime' data-bv-notempty='true' data-bv-notempty-message='reqdatetime 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>description</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='description' type='text' name='description' id='description' data-bv-notempty='true' data-bv-notempty-message='description 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>impression</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='impression' type='text' name='impression' id='impression' data-bv-notempty='true' data-bv-notempty-message='impression 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>recommendation</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='recommendation' type='text' name='recommendation' id='recommendation' data-bv-notempty='true' data-bv-notempty-message='recommendation 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>exampara</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='exampara' type='text' name='exampara' id='exampara' data-bv-notempty='true' data-bv-notempty-message='exampara 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>cardno</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='cardno' type='text' name='cardno' id='cardno' data-bv-notempty='true' data-bv-notempty-message='cardno 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>cardtype</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='cardtype' type='text' name='cardtype' id='cardtype' data-bv-notempty='true' data-bv-notempty-message='cardtype 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>idcard</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='idcard' type='text' name='idcard' id='idcard' data-bv-notempty='true' data-bv-notempty-message='idcard 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>idcardtype</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='idcardtype' type='text' name='idcardtype' id='idcardtype' data-bv-notempty='true' data-bv-notempty-message='idcardtype 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>imgslt</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='imgslt' type='text' name='imgslt' id='imgslt' data-bv-notempty='true' data-bv-notempty-message='imgslt 不能为空'>
				</div>
			</div>


			<div class="form-actions">
				<div class="row" align="center">
					<div class="col-md-12">
					    <button class="btn btn-primary" onclick="location.href='appReportexamList.html'">返回</button>
						<button class="btn btn-primary" type="submit" onclick="add()">
							<i class="fa fa-save"></i> 保存
						</button>
					</div>
				</div>
			</div>

		</fieldset>
	</form>
</div>
	<script type="text/javascript" src="../../js/libs/jquery-2.1.1.min.js"></script>
	<script type="text/javascript" src="../../js/jq.js"></script>
	<script type="text/javascript" src="../../js/plugin/bootstrapvalidator/bootstrapValidator.min.js"></script>
	<script type="text/javascript" src="../../js/common.js"></script>
	<script type="text/javascript" src="../../layui/layui.js"></script>
	<script type="text/javascript">
		layui.use(['layer','laydate'], function(){
		    var layer = layui.layer;
		});
		
		function add() {
			$('#form').bootstrapValidator();
			var bootstrapValidator = $("#form").data('bootstrapValidator');
			bootstrapValidator.validate();
		    if(!bootstrapValidator.isValid()){
			   return;
		    }
		    
		    var formdata = $("#form").serializeObject();

			$.ajax({
				type : 'post',
				url : '/appReportexams',
				contentType: "application/json; charset=utf-8",  
				data : JSON.stringify(formdata),
				success : function(data) {
					layer.msg("添加成功", {shift: -1, time: 1000}, function(){
                        location.href = "appReportexamList.html";
                    });
				}
			});
		}
		
	</script>
</body>
</html>
